生脉注射液联合局部枸橼酸钠抗凝在接受连续性肾脏替代治疗且伴有高危出血倾向患者中的应用  

Application of Shengmai Injections combined with local sodium citrate anticoagulation in continuous renal replacement therapy in patients with high risk bleeding tendency

作　　者：黄彩凤[1] 杨晓帆[1] 黄正米 荣清源 宋林燕 HUANG Caifeng;YANG Xiaofan;HUANG Zhengmi;RONG Qingyuan;SONG Linyan(Department of Critical Care,Anqing First People’s Hospital,Anqing 246000,China)

机构地区：[1]安庆市第一人民医院重症医学科,安庆246000

出　　处：《西北药学杂志》2024年第6期189-194,共6页Northwest Pharmaceutical Journal

基　　金：2021年安徽医科大学校科研基金项目(编号:2021xkj213)。

摘　　要：目的探究生脉注射液联合局部枸橼酸钠抗凝对接受连续性肾脏替代(continuous renal replacement therapy,CRRT)治疗且伴有高危出血倾向患者降钙素原(procalcitonin,PCT)、血清白细胞介素-6(interleukin-6,IL-6)、C反应蛋白(C-reactive protein,CRP)和心肌酶谱水平的影响。方法选择行CRRT治疗并伴有高危出血倾向的患者96例,采用随机数字表法分为对照组(48例)和观察组(48例)。对照组采用局部枸橼酸钠抗凝治疗,观察组采用生脉注射液联合局部枸橼酸钠抗凝治疗,对比治疗前后2组患者急性生理学及慢性健康状况评分系统-Ⅱ(acute physiology and chronic health status scoring system-Ⅱ,APACHEⅡ)、多器官功能障碍综合征评分(multiple organ dysfunction syndrome score,MODS)、凝血功能、炎症因子(PCT、IL-6、CRP)、心肌酶谱水平及不良反应的发生情况。结果治疗前,2组患者的APACHEⅡ、MODS评分及凝血功能比较差异无统计学意义(P>0.05);治疗后,2组患者的APACHEⅡ、MODS评分明显降低,且观察组明显低于对照组(P<0.05);2组凝血酶原时间(prothrombin time,PT)、凝血酶时间(thrombin time,TT)和活化的部分凝血活酶时间(activated partial thromboplastin time,APTT)明显延长,且观察组明显短于对照组(P<0.05)。治疗后,观察组血清PCT、IL-6和CRP水平明显低于对照组(P<0.05)。治疗12、24 h后,2组患者肌酸激酶同工酶(creatine kinase isoenzyme,CK-MB)、肌酸激酶(creatine kinase,CK)水平有升高趋势,但观察组低于对照组(P<0.05)。观察组不良反应总发生率为9.71%,对照组为11.31%,2组比较差异无统计学意义(P>0.05)。结论生脉注射液联合局部枸橼酸钠抗凝可以优化接受CRRT治疗且伴有高危出血倾向患者的凝血功能,降低炎症因子水平,控制心肌损伤程度,控制病情,改善预后,且不增加不良反应发生的风险。Objective To investigate the effect of Shengmai Injections combined with regional citrate anticoagulation on the levels of procalcitonin(PCT),interleukin-6(IL-6),C-reactive protein(CRP)and myocardial enzymes in patients undergoing continuous renal replacement therapy(CRRT)and at high risk of hemorrhage.Methods A total of 96 patients who underwent CRRT and at high risk of hemorrhage were selected,and divided into a control group(48 cases)and an observation group(48 cases)by random number table method.The control group was given regional citrate anticoagulation therapy,while the observation group was treated with Shengmai Injections combined with regional citrate anticoagulation therapy.The acute physiology and chronic health evaluation(APACHE)Ⅱscore,multiple organ dysfunction syndrome(MODS)score,coagulation function,inflammatory factors(PCT,IL6 and CRP),myocardial enzyme levels,and adverse reactions were compared between the 2 groups.Results There was no significant difference in the APACHEⅡscore,MODS score,or coagulation function between the 2 groups before treatment(P>0.05).After treatment,the APACHEⅡscores and MODS scores of the 2 groups decreased significantly,and the observation group had significantly lower scores than the control group(P<0.05).After treatment,the prothrornbin time(PT),thrombin time(TT)and activated partial thromboplastin time(APTT)in the 2 groups were significantly prolonged.The PT,TT and APTT in the observation group were significantly shorter than those in the control group(P<0.05).After treatment,the serum levels of PCT,IL6 and CRP in the observation group were significantly lower than those in the control group(P<0.05).After 12 hours and 24 hours of treatment,the levels of creatine kinase isoenzyme(CK-MB)and creatine kinase(CK)in the 2 groups showed an increasing trend,but the levels in observation group were lower than those in the control group(P<0.05).The total incidence rates of adverse reactions in the observation group and the control group were 9.71%and 11.31%,respectively,

关 键 词：生脉注射液 局部枸橼酸钠抗凝 连续性肾脏替代治疗 高危出血倾向 炎症因子 心肌酶谱 凝血功能 

分 类 号：R983[医药卫生—药品]